Near missed diagnosis of Merkel cell carcinoma in a young immunocompetent woman with a recurrent left-arm mass: A case report.

Merkel cell carcinoma (MCC) is a rare, aggressive neuroendocrine cancer that primarily affects the elderly, Caucasians, and the immunocompromised. We present a rare case of an immunocompetent young Iranian (non-Caucasian) female with a small nodule on her left arm. The lesion was initially misdiagnosed as an infected cyst and was treated with antibiotics for 20 days before being surgically removed. Unfortunately, the lump regrew rapidly 2 weeks later, when she had a biopsy, which revealed stage III MCC. She was then treated with adjuvant chemoradiotherapy after a thorough surgical resection of the tumor. Despite the fact that she was in remission after completing chemotherapy courses, she developed neutropenic fever, sepsis and died from septic shock. This case emphasizes the necessity of early clinical diagnosis of MCC and obtaining a biopsy with histopathologic evaluation of rapidly evolving skin lesions suggestive of malignancy.

Effect of Methylphenidate on Orthodontic Tooth Movement and Histological Features of Bone Tissue in Rats: An Experimental Study.

INTRODUCTION: Methylphenidate is a psychostimulant drug, which is commonly used by children and teenagers. This age group receives most orthodontic treatment. Effect of this drug on tooth movement is unknown. AIM: The aim of this study was to evaluate the effect of methylphenidate on orthodontic tooth movement and histological features of bone tissue in rats. MATERIALS AND METHODS: Forty-two Wistar rats (male) were selected and divided to three groups, randomly (n=14). The control group (Group 1) received no drug, the experimental Group 2 received a constant dose of methylphenidate daily for 14 days while the experimental Group 3 received increasing doses of methylphenidate daily. To exert force, a NiTi coil spring was placed between the maxillary right first molar and the maxillary right central incisor. At the end of the study period, the amount of tooth movement was measured and then the rats were sacrificed for histological analysis of bone tissue. Differences between the experimental groups were analysed using Kruskal-wallis and Mann-Whitney U tests. RESULTS: No significant differences were found in the amount of orthodontic tooth movement or osteoclasts and lacunae, between the experimental groups (p>0.05). Mann-Whitney U analysis showed significant differences in the depth of resorption lacuna between Group 2 and 3 (p=0.037). CONCLUSION: Methylphenidate has no significant effect on orthodontic tooth movement or histological features of bone tissue in rats.

Lack of Evidence for a Relationship between High Risk Human Papillomaviruses and Breast Cancer in Iranian Patients.

BACKGROUND: Whether there is any relationship between human papilloma virus (HPV) and breast carcinoma is not clear. Some previous studies have indicated a possible role in oncogenesis in the breast. In this study, we therefore analyzed the presence of HPV infection in breast tissues of Iranian women from Yazd city. MATERIALS AND METHODS: In a cross-sectional study, formalin-fixed paraffin-embedded tissues from 87 patients with breast cancer and 84 cases with breast fibrocystic lesions (control group) were selected from a tissue archive. Grade of tumors and fibrocystic tissues were determined by two pathologists. The nested-PCR method was performed for detection of HPVs in samples. HPV genotypes were determined by sequencing and the phylogenetic tree depicted by MEGA software. RESULTS: Of the 87 women with breast cancer, 22.9% (20 isolates) had positive results for HPV DNA. In the control group no HPV was detected. The HPV genotypes in positive samples were HPV-16 (35%) HPV-18 (15%), HPV-6 (45%) and HPV-11 (5%). The data did not approved a significant correlation between tissue pathology of breast cancer and the HPV genotype frequency. CONCLUSIONS: The data did not provide any evidence for a role of high risk HPV types in oncogenesis in the breast.

Clinicopathological Features and Survival Rate of Colorectal Adenocarcinoma Patients with and without a KRAS Mutation: a FiveYear Study in Yazd, Iran.

BACKGROUND: By some estimates, colorectal carcinoma is the third most common cancer worldwide. The most appropriate method of treatment, especially of its metastatic form, is determined based on KRAS status. The present study was conducted on patients with colorectal cancer positive or neagtive for a KRAS mutation in terms of survival rate and the response to treatment. MATERIALS AND METHODS: Medical records of all cases with colorectal cancer hospitalized from 2010 to 2015 and with KRAS testing results were studied. Data such as gender, age, tumor (size, grade, location, stage), treatment type, KRAS status and survival were considered as variables. Survival analysis was performed using the KaplanMeier method and Logrank test. Statistical significance level was defined as P value <0.05. RESULTS: Out of 90 patients, 55 (61.2%) were male and 35(38.8%) were female with the age range of 2287 years. The overall disease specific survival was 53±3 (Mean ± SE) months with 95%CI:4760, and there were statistically significant differences between the mean survival rate with tumor stage and the response to treatment (log rank test, PV=0.007 and PV=0.001) respectively. The risk of mortality was 2.02 times higher in patients with mutant KRAS compared to those with the wild type of the gene; however, this difference was not statistically significant (OR=2.016; 95%CI: 0.685.9; PV=0.197). CONCLUSIONS: In our study the overall 5year disease specific survival rate was low as compared to similar studies elsewhere. Significant correlations were found between survival time with treatment type and tumor stage.

Ultrasound Assistance In Differentiating Malignant Thyroid Nodules From Benign Ones.

BACKGROUND: The search is ongoing for simple, effective ways to identify and differentiate thyroid nodules in order to avoid invasive procedures. This study aims to perform an ultrasound assessment of clinically suspected patients with malignant nodules, to perform a fine needle biopsy on them, and to compare the results obtained. METHODS: In total, 135 patients with thyroid nodules suspected to be malignant in the ultrasound underwent ultrasound-guided fine needle biopsies. The patients' gender, age, ultrasound views (echogenicity, shape, and calcification type), nodule size, number of nodules, and needle biopsy results were retrospectively evaluated. RESULTS: Of the 135 patients, 117 (86.7%) were female and 18 (13.3%) were male. In terms of age, 67 (49.16%) were younger than 40 and the rest were older. According to the Chi-square test, a significant relationship was found between the type of nodule and calcification found in the ultrasound views (p=0.001). The nodule type was not significantly related to gender (p=0.563) or to the number of nodules (p=0.128); however, there was a significant relationship between nodule size and type (p=0.001). Ultrasound specificity, sensitivity, positive and negative predictive values, and accuracy for differentiating benign from malignant nodules were 93.2%, 93.8%, 81.1%, 98%, and 93.3%, respectively. CONCLUSIONS: Ultrasound views (comet tail artefact and linear echogenic foci) were better predictors of benign nodules than of malignant ones, while round, echogenic foci, brighter and larger than typical micro-calcifications without any visible echoes and multiple punctuate round echogenic foci were better predicted malignancy.

Clinicopathological Features of Adrenal Tumors: a Ten-year Study in Yazd, Iran.

BACKGROUND: Adrenal tumors are relatively uncommon, and have different presentations, so we decided to evaluate the clinico-pathological characteristics of benign and malignant tumors in a ten-year period. MATERIALS AND METHODS: This cross sectional-analytical study was conducted on adrenal resection samples taken during 2004-2014 in three hospitals in Yazd province. Data were analyzed using SPSS software, version 17. Chi-square and Fisher's exact test were used as appropriate Results: A total of 71 patients with adrenal tumors were analyzed, including 32 (45.1%) men and 39 (54.9%) women with an overall mean age 37.7±19.9 (range: 6-75 years). Some 50.7% of lesions were benign and 49.3% were malignant. Neuroblastoma was the most malignant lesion (32.3%) followed by adrenocortical carcinoma (8.4%). Among the benign lesions pheochromocytoma was the most common (25.3%) followed by adrenocortical adenoma (12.6%). While 64% of tumors were functional 36% were non functional. Significant correlation was seen between the age of patient and type of tumor (P=0.001). In patients between 14-40 years old no malignant lesions was found, although under 14 years old all of the tumors were malignant. Malignant lesions mostly presented with abdominal pain, abdominal mass and anorexia (57.2%, 45.7% and 45.7%) respectively. Benign lesions mostly presented with paroxysmal hypertension, headache and abdominal pain (61.2%, 47.2% and 44.4%) respectively. CONCLUSIONS: Since the trend of adrenal tumors is on the rise based on this and other studies, suspected cases should undergo prompt hormonal and radiological assessment. Early diagnosis and treatment could prevent tumor progression and reduce mortality and morbidity rates.

Fungal Orbital Infection Mimicking Malignancy in a Girl.

Fungal infection of the orbit is rare especially among immunocompetent patients. We present a 9-year-old girl with peri-orbital, eyelid and internal canthus swelling of the left eye. Clinical impression was suggestive of malignant tumor such as rhabdomyosarcoma or lymphoma. Histopathological examination of biopsied tissue revealed necrotizing granulomatous inflammation confirmed as fungal infection. Complete response to antifungal therapy was noted after four months.

CLINICOPATHOLOGICAL FEATURES OF LIVER TUMOURS: A TEN-YEAR STUDY.

BACKGROUND: Various diseases affect the liver, among them, malignant and benign tumours with hepatic nodules are the most important. We aimed to evaluate the clinicopathological findings related to hepatic tumours and nodules. METHODS: This retrospective study was carried out during November 2014 to August 2015 by reviewing the hospital medical records of 164 registered patients with liver biopsies referred to Shahid Sadoughi educational General Hospital, Yazd, Iran, between 2004 and 2014. The samples were selected through the census method. Age, gender, clinical symptoms, initial clinical diagnosis, pathology reports and ultrasound results were considered as variables. Data were analysed by using SPSS-17. RESULTS: There were 87 (53%) men and 77 (47%) women. The mean ages of presentation for malignant and benign tumours were 57.9 ± 17.2 and 44.9 ± 19.4 years, respectively. Seventy benign tumours and 147 malignant tumours were recorded. The most frequent chief complaint was abdominal pain (54.9%) in both malignant (56.50%) and benign tumours (41.20%). Hepatocellular carcinoma (HCC) and hemangioma were the most prevalent malignant and benign hepatic tumours, respectively. In our study, correlation between pathology reports and primary diagnoses was 40.9%, and a significant relationship was found between sonography and pathological findings (p = 0.038). CONCLUSIONS: We found that only when primary clinical diagnosis and sonography were in favour of malignancy, they were correlated with pathology results. Clinicopathological assessments can help physicians in their diagnosis in order to facilitate the management of hepatic tumours.

Overexpression of HER-2/neu in patients with prostatic adenocarcinoma.

BACKGROUND: Prostatic adenocarcinoma is one of the main causes of cancer death, and its timely diagnosis and preventing its progression dramatically helps improve life indexes. Given the high disease recurrence rate, today, research is more inclined toward exploring causes of recurrence and development, and innovation of modern treatment methods. Several studies have explored over-expression of human epidermal growth factor receptor 2 (HER-2/neu) in prostatic cancer so far, with different results. Thus, it was decided to investigate HER-2/neu overexpression in patients with prostatic adenocarcinoma in Iran. MATERIALS AND METHODS: A sample size of 40 patients with prostate cancer entered the study, using a cross-sectional, non-randomized sampling method. Parameters studied included patient age at surgery, Gleason score, serum prostatic specific antigen (PSA) before surgery, and positive sample rate after immunohistochemical staining to investigate HER-2/neu overexpression. RESULTS: In terms of HER-2/neu receptor staining rate, of 40 slides, 16 (40%) scored 0, 13 (32.5%) 1+, 7 (17.5%) 2+, and 4 (10%) 3+. In total 27.5% of slides showed HER-2/neu overexpression. In terms of age, an inverse correlation was found (-0.181), but without significance (p=0.263). In terms of serum PSA, the correlation coefficient was 0.449 (p=0.004). With respect to Gleason score, the coefficient was 0.190 (p=0.240). CONCLUSIONS: In this study, HER-2/neu overexpression occurred in 27.5% of prostate cancer cases, which is a relatively high figure, compared to similar studies elsewhere. While, we failed to reveal any relationship between HER-2/neu expression status with progression and prognosis of disease, it was demonstrated that the serum PSA level was significantly higher in cases with increased receptor expression.

Juvenile xanthogranuloma presenting as a large neck mass and ocular complications: a diagnostic and therapeutic dilemma.

Juvenile xanthogranuloma is a non-Langerhans cell histiocytosis that originates from dendritic cells. Dendritic cells can accumulate in the skin of the head, neck, trunk, arms and legs. They may also involve other tissues such as the bones, lung, liver, heart, bone marrow, central nervous system, spleen and large intestine in rare cases. We report a rare case of juvenile xanthogranuloma in a 16-year-old girl who presented with a neck mass and left-sided ptosis 2.5 months previously. Excisional biopsy of the neck lesion revealed proliferated histiocytes admixed with numerous eosinophils and multinucleated giant cells that simulate eosinophilic granuloma; however, the histiocytes were negative for CD1a, CD123 and S-100 protein and positive for CD68 and CD14. The course of the disease led to treatment of the patient with chemotherapy, followed by low-dose radiotherapy.

Survival of patients with prostate cancer in Yazd, Iran.

BACKGROUND: Prostate cancer is the second leading cause of cancer death in men worldwide. Several factors such as availability of screening tests, and dietary, other lifestyle, environmental and genetic influences contribute to worldwide disparities in prostate cancer incidence and mortality rates. Our aims were to investigate patient characteristics at the time of diagnosis, common treatment strategies employed and survival in an Iranian male population with prostate cancer. MATERIALS AND METHODS: Archives of Pathology Departments of five referral centers affiliated with the School of Medicine of Shahid Sadoughi University in Yazd province were reviewed. Paraffin-embedded blocks were reviewed by two independent pathologists to confirm the diagnosis. The latest modification of the Gleason Scoring System was adopted to determine pathological grading. Following pathological evaluation, patients were contacted via telephone to acquire information regarding their current status. RESULTS: Pathology blocks were available for 113 patients. However, upon phone contacts, we were unable to determine the survival status in 23 patients (response rate=83%). Therefore, 90 patients were enrolled in the final analysis. The median follow-up time was 6.0 years (ranging from 0.3 to 8.8 years). There were 30 death attributed to prostate cancer in the study group. Kaplan-Meier analysis revealed that patient age at the time of diagnosis was a significant predictor of survival. Another significant predictor of poorer survival was higher tumor grade. CONCLUSIONS: Our observations indicate that age and pathological grade can negatively affect survival of individuals with prostate cancer in Iran.

Clinicopathological findings and five year survival rates for patients with central nervous system tumors in Yazd, Iran.

BACKGROUND: The incidence rate of brain tumors has increased more than 40% in the past 20 years, especially in adults. We aimed to study the clinical and pathological findings of central nervous system (CNS) tumor patients and to evaluate their 5 year survival rates. MATERIALS AND METHODS: The archives of all patients with CNS tumors in 6 health care centers in Yazd, Iran, from 2006 to 2013, were studied. Patients data were extracted using a checklist which included age, sex, date of reference and diagnosis, date of death, clinical signs, radiography findings, pathology report, size and location of tumor, patient treatment and grade of tumor. RESULTS: A total of 306 patient records were studied in the 8 year period. The most prevalent type of tumor was astrocytoma (n=113, 36.9%). The frequency of almost all tumor types was statistically higher in male patients (p=0.025). In most cases surgery with radiotherapy was the treatment of choice (49.3%). The most frequent symptom reported was headache (in 60.8% of patients) followed by convulsions (15.7%). Most of the tumors were located in the right hemisphere (46.1%) and the frontal and parietal lobe (26% and 12%, respectively). Radiography findings displayed edema with a nonhomogeneous lesion in majority of the patients (87%). The survival fraction of the patients with malignant tumors decreased over time (0.807 in the first year and 0.358 at the end of the 5th year). CONCLUSIONS: Astrocytoma was the more common CNS tumor with male predominance. Overall survival rates of malignant tumors decreased over time and this was in relation with tumor grade.

Endometrial stromal sarcoma of the uterus presenting as pulmonary metastasis.

Endometrial stromal sarcoma (ESS) is a rare uterine sarcoma. Compared with other uterine malignancies, it occurs at an earlier age (42-58 years) and about 10-25% of the patients are premenopausal. The tumours have an indolent growth, with a tendency for late recurrence. Metastases are rarely detected before the diagnosis of the primary lesion. We report a case of ESS with pulmonary metastasis as a prodromal manifestation.

Isolated cerebellar tuberculoma mimicking posterior cranial fossa tumour.

Isolated central nervous system (CNS) tuberculoma is a rare disease. This disease is associated with high morbidity and mortality, despite modern methods of detection and treatment. CNS tuberculosis can present as meningitis, arachnoiditis, tuberculomas or the uncommon form of tuberculous subdural empyema and brain abscess. We present the clinical, radiological and pathological findings of cerebellar tuberculoma in an Iranian immunocompetent patient mimicking a malignant tumour.

Basidiobolomycosis a mysterious fungal infection mimic small intestinal and colonic tumour with renal insufficiency and ominous outcome.

Basidiobolomycosis is a rare fungal infection caused by Basidiobolus ranarum a worldwide environmental saprophyte fungus that is potentially a pathogen. B ranarum mainly affects the subcutaneous tissues but gastrointestinal and disseminated infections rarely have been reported previously. We report a case of B ranarum infection in a 12-year-old immunocompetent boy presented with abdominal pain from 2 months earlier before admission in the hospital. Abdominal CT scan revealed a lobulated mass-like lesion in the vicinity of right lower quadrant enveloping ascending colon and terminal ileum with involvement of mesentery. Histopathological examination showed severe full-thickness infiltration of inflammatory cells mainly eosinophils admixed with multinucleated giant cells and large areas of necrosis with granulomatous feature. Periodic acid Schiff staining demonstrated thin-walled septate fungal hyphae's surrounded by eosinophilic material (Splendore-Hoppeli phenomenon) identified as a basidiobolomycosis.

Primary parapharyngeal and skull base synovial sarcoma in a 13-year-old boy with neurofibromatosis radiologically misdiagnosed as a benign lesion.

Synovial sarcoma is a rare form of malignant tumour and accounting approximately for 8% of all soft tissue sarcomas. Head and neck synovial sarcomas are uncommon and parapharyngeal space involvement is extremely rare. We report a case of synovial sarcoma in the parapharyngeal space of a 13-year-old boy with a history of neurofibromatosis presented with odynophagia, ptosis and left submandibular mass. The lesion extended from retrostyloid parapharyngeal space to the skull base and foramen jugular superiorly. The first clinical and radiological impressions were carotid jugular related tumours such as schwannoma and paraganglioma.

Incidence and trends of malignant and benign pancreatic lesions in Yazd, Iran between 2001 and 2011.

BACKGROUND: Despite recent valuable steps in initiating a cancer registry in Iran, data depicting prevalence, incidence, and clinical picture of pancreatic tumors in the country are exceedinglyly sparse. With the aim of filling this knowledge gap, we reviewed cases in the pathology archive of Shahid Sadoughi hospital (Yazd, Iran), between 2001 and 2011. MATERIALS AND METHODS: Medical records of 177 patients are reported in the present study. In cases for which paraffin-embedded blocks were available, the specimens were evaluated by two independent pathologists blinded to the primary diagnosis. We extrapolated the frequency of malignant lesions in our study to the population of Yazd province, derived from national census data, to generate cancer incidence rates. RESULTS: Final diagnosis of malignancy was made in 117 cases (66.1%), and the remainder (60 lesions, 33.9%) were classified as benign. Adenecarcinoma and neuroendocrine tumors were the two most common histological types of malignancy identified in 88 (75.2%) and 11 (9.4%) specimens, respectively. Crude annual incidence of pancreatic cancer was 0.55 per 100,000 person in 2001 and increased to 1.68 in 2011. Age standardized incidence rates in 2001 and 2011 were 0.75 and 2.68, respectively. A significant increasing trend in cancer incidence was observed during the 11 years of the study period (r =+0.856, p=0.009). Sex-stratified analysis, confirmed the observed trend in men (r=+0.728, p=0.034), but not women (r=+0.635, p=0.083). CONCLUSIONS: Over the past decade, incidence of pancreas malignancies has risen steadily in Yazd, Iran. Nevertheless, these figures are still substantially lower than those prevalent in developed nations.

Clinically malignant atypical glomus tumour.

Glomus tumours (GTs) resemble the normal glomus body and have a predilection for skin and subcutaneous tissue. Although the majority of glomus tumours are small, benign neoplasms that occur in the dermis or subcutis of the extremities and cases of atypical or malignant variants have been reported. We report a case of a man who presented with a 1-year history of subcutaneous nodule in the right scapular area which was mildly tender. The nodule measured 2 cm. Microscopic examination showed features of glomus tumour with increased mitotic activity. These features, by current definition, would suggest glomus tumour of uncertain malignant potential. Three months later, he presented with recurrence. During his metastasis work-up, we noticed bilateral pulmonary metastasis. Metastasising GTs are rare. The patient underwent wide local excision and received chemotherapy.

Survival of patients with lung cancer, Yazd, Iran.

BACKGROUND: Lung carcinoma is the leading cause of cancer mortality worldwide. Although the 5-year survival rate nearly tripled from 5-15% over the last 25 years, the estimated number of deaths still exceeds 1.3 million annually. The overall 5-year survival of lung cancer is only 10% in Europe and 15% in the United States. The aim of the current study was to determine the long-term survival and the effect of certain prognostic factors on survival of patients with lung cancer in Yazd city, Iran. METHODS: In this cross-sectional descriptive study, we retrospectively reviewed hospital records and follow-up data of 148 patients with histological proven lung cancer using the cancer data registered between 1998 and 2005 in the pathology department of Shahid Sadoughi educational hospital, Yazd, Iran. Data were extracted from patient documents that included sex, age, clinical manifestations, histopathological report of the tumor and type of treatment given. RESULTS: Overall survival time in all patients was 8.5 months after diagnosis and there was no significant difference in survival according to sex (p=0.958). Histological analysis revealed that squamous cell carcinoma was the most common histologic type (35%). Kaplan-Meier statistical methods estimated the average survival time for SCC to be better (22.6 months) in comparison with the other types of histology (all of them below 10 months). There was a trend towards significance between type of histology and duration of survival (p=0.08). CONCLUSION: It is reasonable to expect that early lung cancer detection, and appropriated treatment, may improve surgical morbidity and mortality. Low survival of lung cancer in our center patients show our shortages in screening programs for early diagnosis. Designing studies with larger sample size that take some other variables like staging of patients is now necessary.

Effect of direct electric current on parietal bone osteogenesis.

INTRODUCTION: It has been shown that biphasic electric stimuli may be effective in stimulation of bone growth. This study aimed to evaluate the role of direct electric current on osteogenesis of the parietal bone in a canine model. MATERIALS AND METHODS: After surgical implantation of assembly involving 3 electrodes in the parietal bones in 5 adult male dogs, 20-MA direct electric current was applied. As a control group, a neutral assembly was implanted on the contralateral side of the calvaria.After 45 days of implantation, through a second surgical procedure, the bone samples were taken off the implantation sites and subjected to histologic evaluation. The data were analyzed with SPSS 16 software package (SPSS Inc., Chicago, IL) using Chi-squared and Fisher exact tests. RESULTS: The bony tissues from all tissue sample sites were viable. Foreign body reaction that was documented by the presence of giant cells was observed in all samples. Histologic evaluation of samples revealed no statistically significant difference with respect to inflammatory reaction, bony trabecular thickness, bone arrangement, and maturation among the 3 electrode types (P > 0.05). CONCLUSIONS: Direct electric stimulation of the parietal bone in this canine model revealed no statistically significant difference with respect to inflammatory reaction, bony trabecular thickness, bone arrangement, and maturation.